Active NPI
Maen Qatoum
- Pharmacist
- Decatur, IL
National Provider Identifier
1285237099
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 051.300964
- Practice address
- 355 W Mound Rd
Decatur, IL 62526-1965 - Phone
- (217) 875-6550
- NPI assigned
- Nov 16, 2020
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 051.300964 | IL | Primary |
Addresses
Primary practice location
355 W Mound Rd
Decatur, IL 62526-1965
Mailing address
355 W Mound Rd
Decatur, IL 62526-1965
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 051.300964 | IL | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Decatur Pharmacyxpress LLC | Current | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Community/Retail Pharmacy
- Decatur, IL
- NPI 1760379465
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1605484800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1605484800000",
"number": "1285237099",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "355 W MOUND RD",
"city": "DECATUR",
"state": "IL",
"postal_code": "625261965"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "355 W MOUND RD",
"city": "DECATUR",
"state": "IL",
"postal_code": "625261965",
"telephone_number": "217-875-6550"
}
],
"practiceLocations": [],
"basic": {
"last_name": "QATOUM",
"first_name": "MAEN",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2020-11-16",
"last_updated": "2020-11-16",
"certification_date": "2020-11-16",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Pharmacist",
"state": "IL",
"license": "051.300964",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Decatur, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 16, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.